全身麻醉与腰硬联合麻醉在老年股骨颈骨折手术中的应用

Application of general anesthesia and combined lumbar and epidural anesthesia in the operation of femoral neck fracture in elderly patients

目的比较全身麻醉与腰硬联合麻醉在老年股骨颈骨折手术中的应用效果。方法选择本院2020年1月至2021年12月收治的老年股骨颈骨折患者86例,随机分为对照组和观察组各43例。对照组采用全身麻醉,观察组采用腰硬联合麻醉,比较两组手术过程中的麻醉效果。结果两组肌松效果比较,观察组优于对照组(P>0.05),术后6h观察组VAS评分低于对照组(P<0.05),观察组感觉、运动阻滞起效时间均短于对照组,感觉、运动阻滞维持时间以及最大感觉、运动阻滞时间均长于对照组,最大感觉阻滞面低于对照组(P<0.05),对照组各时间点HR、MAP比较,差异均有统计学意义(P<0.05),观察组T_(2)、T_(3)、T_(4)时间点HR、MAP均高于对照组,手术时间短于对照组,术后1h、6h及12h MMSE评分均高于对照组(P<0.05),观察组术中及术后不良反应发生率均低于对照组(P<0.05)。结论腰硬联合麻醉应用于老年股骨颈骨折手术麻醉效果更好,起效快,感觉及运动阻滞完全,不良反应发生率低,安全性较高,值得在临床进一步推广。

Objective To compare the effect of general anesthesia and combined lumbar and epidural anesthesia in the operation of femoral neck fracture in elderly patients.Methods A total of 86 elderly patients with femoral neck fracture admitted to our hospital from January 2020 to December 2021 were randomly divided into control group and observation group,with 43 cases in each group.The control group was treated by general anesthesia,the observation group was treated by combined lumbar and epidural anesthesia.The anesthetic effects of the two groups were compared.Results Two groups of muscle relaxant effect had no significant difference(P>0.05).The VAS score 6 hours after operation of the observation group was lower than that of the control group(P<0.05).The sensory and motor block time in the observation group were shorter than those of the control group,the sensory and motor block maintain time and maximum sensory and motor block time were longer than those of the control group,the maximum sensory blockade plane was lower than that of the control group(P<0.05).There were statistically significant differences in HR and MAP at each time point in the control group(P<0.05).HR and MAP at T_(2),T_(3)and T_(4)in the observation group were higher than those in the control group(P<0.05).The operation time in the observation group was shorter than that in the control group(P<0.05).The MMSE score aT_(1)h,6h and 12h after operation in the observation group were higher than those in the control group(P<0.05).The incidence of intraoperative and postoperative adverse reactions in the observation group was lower than that in the control group(P<0.05).Conclusion Combined lumbar and epidural anesthesia in the elderly patients with femoral neck fracture has better anesthesia effect,fast onset,complete sensory and motor block,low incidence of adverse reactions,high safety,and is worthy of further clinical promotion.